The overall aim of the Phase I pilot study is to set the stage for subsequent testing of the effectiveness of a multi-phase management strategy for persons with dementia-related anxiety and agitation, which serves to enhance their daily function and delay nursing home placement. The Phase I study begins the process by examining and refining data collection instruments, procedures, and inclusion criteria; evaluating the acceptability and usefulness of proposed screening and outcome measures; and exploring the role of genetic risk factors in the development of late life anxiety. Phase I will also allow for modifications of the PLST intervention for application in assisted living facilities (ALFs), and development of a Caregiver Manual for use in Phase II. Phase II and III treatment strategies involve systematic evaluation and intervention plans that optimize care from a nursing, medical, environmental and pharmacologic perspective (only Phases I and II are part of this proposal). These approaches are based on research demonstrating that environmental stressors, cognitive state, behavioral symptoms and caregiver burden influence loss of independent living status. Hence, it is essential to address most if not all of these factors to enhance function in a way that may delay institutionalization. Thus, 'multi-modal' treatment interventions, such as the one proposed by the PI in her renewed program of research, may achieve better outcomes. The Phase Il/Year 02 study involves preliminary testing of a combination strategy to manage anxious behaviors in persons with dementia who reside in ALFs (medical optimization and PLST) using a repeated measures design with subjects serving as their own control (N=40). [unreadable] [unreadable]